Alice Rothchild is a physician, activist and writer based in Boston. She is the author of Broken Promises, Broken Dreams (Pluto, 2007; 2010) and serves on the regional steering committee for American Jews for a Just Peace. The following blog post is the nineteenth and last in the series documenting her current work in Palestine as part of the American Jews for a Just Peace – Health and Human Rights Project.
I am sitting in Ben Gurion Airport watching all the Christian pilgrims leaving the Holy Land. We are traveling on the Sabbath so we are avoiding the ultra Orthodox Jews and yes, I am doing my own racial profiling, but they look like goyim, have southern accents, are smiling in that unambivalent kind of way, and this is, after all, Israel. So forgive me. Last night I shredded all my computer files, hid my camera memory card, placed anything from the West Bank at the bottom of my suit case under the dirty underwear, all in preparation for the ‘are you Jewish enough and politically kosher’ testing that often occurs in the multiple layers of Israeli airport security.
As we approach the airport, we are stopped and the taxi trunk is searched. Our driver explains this always happens when the driver is Palestinian (which is totally determined by the face, the accent, the look in the eyes, since the car has yellow license plates). In the airport, a sincere young man explains to me that someone may have put a bomb in my suitcase, (how about in my brain?) and wants to know if I know anyone in Jordan, but with my nice Jewish face and nice Jewish name, and a few gray hairs, I have no trouble.
I spent the last three days in the West Bank working/observing in three Palestinian Medical Relief women’s clinics in Qalqilya, Kufor Lakef, and Tulkarem, where medicine and occupation and the fragmentation of health care all come together. One doctor is a lovely Romanian woman who met her Palestinian husband when they were studying in Romania, another is a Russian with a similar story and the third is a West Banker who studied in Bulgaria, also with her doctor husband. They all have children and challenging lives. Tragically the first doctor’s husband was sitting on a balcony last year when it collapsed, leaving him a paraplegic. The Russian woman, who is seeing all the men, women, and children who show up because the family doctor did not make it, introduces herself and then states, “I am not happy.” I cannot tell if that is a comment about her impossible day or her impossible life. I get the sense that the women who came here for love, all got much more than they bargained for, and their perseverance and dedication is impressive. Last year, many clinicians were not paid for months when the Palestinians were punished for daring to ask for recognition in the UN. That can be demoralizing as well as financially catastrophic. “We cannot plan for our futures.”
The clinics are all a strange mix of first and third world medicine and the medical problems are like health care issues anywhere with an overlay of occupation and cultural traditions. The weighing scale is prehistoric, obviously not calibrated, and the women are weighed with all their multiple layers. How accurate can that be? There are many pregnant women and just about everyone pregnant or not pregnant, gets an ultrasound. The ultrasound machines are all ancient, some covered with grime and gel, the doctors quite skilled but rushed, (no one has a full bladder which is imperative for a quality exam), the indications seem more social than medical. Women frequently present for vaginal issues, refuse a pelvic exam, then get an ultrasound and a script for yeast medication. This seems somewhat dependent on how the doctor presents the need for an exam, but, from my first world vantage point, this is practicing gynaecology without the data for a correct diagnosis. Mostly it feels to me like a waste of resources and a prescription for incorrect diagnoses and repeat visits. I also notice an overuse of antibiotics, a mix of patient expectation and best guessing. On the other hand, since patients pay for testing and for medications, the doctors are making financial decisions in terms of how to give the most care for the fewest shekels. So it is complicated at best and I can see that the essentials are covered: pregnant women are taking folic acid and iron, they have prenatal records they bring to each visit wherever that may happen, IUDs are inserted using sterile technique, etc. Continue reading